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Flashcards in aortic stenosis and regurg Deck (29):
1

2 possible pathologies leading to A stenosis

1. bicuspid valve
2. degenerative
-calcification or rheum

2

what is the mech of problems with stenosis

1. outflow obstruction
2. pressure hypertrophy, diastolic dysfunction, ischemia
3. Sx
4. death

3

what is pressure hypertrophy

LV pressure overload induces genes that promote concentric hypetrophy - big wall
- end up with muscle bound heart that can't pump forward properly

4

what are important points of progresson in A stenosis

- 50% reducdtion in orifice leads to minimal gradient
- beyond this there are exponential increases
- variable between people

5

3 clinical manifestation

1. angina pectoris
2. syncope
3. dyspnea

6

2 parts of angina pectoris

1. low supply
- endocardial compression
- assoc. CAD
2. high demand
- LV hypertrophy
- myocardial o2
- wall stress

7

what is syncope

-classically exertional
- may also be from an arrythmia

8

what is dyspnea

1. LV hypertrophy
- diastolic dysfunction
2. progressive LV dilatiation and contractile failure
- systolic dysfunction
signs and Sx of HF

9

when is sudden death

0.3% per year in asymptomatic PT
- malignant tachy or brady cardia

10

what is nat. Hx

long asymptomatic latent period
- onset of Sx is a bad sign

11

what is murmur like in stenosis worsening

as it get worse, it comes later and get harsher

12

what is bicuspid valve

- prone to stenosis and regurg
- assoc. with AAA
- risk for aortic dissection, not coarctation
- risk for endocarditis

13

5 parts of workup

1. ECG
- LA enlargement, LV hyper
2. CXR
- post stenosic Aortic dilatation
3. ECHO
- thick and restricted leaflets
- gradient and vavle area can be calculated
4. Cath
- gradient across valve and valve area
5. stresst testing
- for prognosis

14

3 severity levels and measurments

mild - 40mmHg

15

what is med. mgmt

mech problem = mech Tx
- afterload reducing drugs contraindicated

16

4 reasons stenosis important

1. common
2. major clinical implications
3. morbid once Sx
4. treatable

17

5 common errors in stenosis

1. failure to disting sclerosis from stenosis
2. failure to diagnoe/investigate
3. failure to act once Sx there
4. prescribing afterload reducing agents
5. abrupt reduction in preload/afterload

18

3 possible causes of A regurg

1. diseased valve cusps
- calc, bi cusp, rhuem
2. diseased aortic root
3. acute patho
- dissection, trauma, endocarditits

19

what is pathophys is acute

- acute Vol overload leads to high filling P
- LV doesn't have time to accom.
- stroke vol goes up a bit, but not enough to deal with all the extra
- low forward output and high L atrium pressure

20

what is patho in chronic

- get eccentric hypertrophy - cor bovinum
- v. large strok vol get blood forward well
- ejection fraction remains the same
- can stay compensated for a long time

21

what happens in decomp.

- eventual LV fibrosis and systolic dysfunction
- wall tension and pressure rises over time
- evenutally ejection fraction falls

22

what is natural Hx

- asymptomic for decades
- remodelling is asymptomaic for a while
- then get Sx and it is bad

23

3 main Sx of regurg

1. palplitations - due to hyperdynamic stroke volume
2. failure
-dyspnea on exertion, orthopnea, fatugue
3. angina, syncope

24

what is heart sound with regurg

high pitched early diastolic murmur

25

4 tests

1. ECG - LVH
2. CXR - megaly
3. ECHO
4. cath

26

5 parts of med mgmt

1. surveillance ECHO
2. avoid bradycardia
3. vigilance against endocard
4. diuretics
5. vasodilators

27

indications for surg

definite
- Sx with normal ejection fraction
- Sx with mild decrease EF
v. prob
- Asx but with sever LV dilatation
probable
- severe LV systolic dysfunction

28

2 common errors

1. failure to monitor for asymptomatic but irreversible LV remodelling
2. over-reliance on meds on remodellig occurs

29

what is surg

valve replacment

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